Chapt 49 - Urinary Disorders
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| What is the primary function of the kidney? | Excretion of water
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| Where are the kidney's located? | Behind the peritoneum (retroperitoneal)
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| What are the three major functions of the nephron? | Controlling body fluid levels by selectively removing or retaining water, assisting with the regulation of the pH of the blood, and removing toxic waste from the blood
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| What is the blood flow through the nephron? | Afferent arteriole, Filtration in glomerulus, Reabsorption in proximal convoluted tubule, Reabsorption in loop of Henle, Secretion in distal convoluted tubule, Efferent arteriole (AFRRSE)
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| What are the three phases of urine formation? | Filtration of water & blood products, reabsorption, secretion
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| What happens to the BP when the body experiences increased fluid loss through hemorrhage, diaphoresis, vomiting, diarrhea, or other means? | Drops
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| What hormone does the posterior pituitary gland release which causes the distal convoluted tubules to increase their rate of water reabsorption? | ADH
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| What raises the BP to a more normal level and causes urine to become concentrated? | Action of ADH which returns water to bloodstream
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| What is the albumin level in urine? | None
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| What is the normal glucose level in urine? | None
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| What is the normal erythrocyte level in urine? | None to trace
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| What is the normal ketone level in urine? | None
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| What is the normal leukocyte level in urine? | None or trace
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| What is the normal pH level in urine? | 4.6-8.0
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| What is the normal color of the urine? | Yellow/Clear
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| What is the normal clarity/turbidity of the urine? | Clear
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| What are the possible causes of albumin in the urine? | Renal disease, increased blood pressure, or toxicity of the kidney cells from heavy metals
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| What does glucose in the urine indicate? | High blood glucose levels
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| What does erythrocytes in the urine indicate? | Infection, tumors, or renal disease
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| What occurs when there are ketones in the urine? | Too many fatty acids are oxidized
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| What does it mean when leukocytes are found in the urine? | Infection in the urinary tract
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| What are abnormal colors of urine? | Amber or orange
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| What is abnormal clarity of urine? | Cloudy
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| What does increased specific gravity indicate? | Dehydration (fever, diaphoresis, vomiting, diarrhea)
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| What does BUN (Blood Urea Nitrogen) test determine? | Kidney's ability to rid the blood of non-protein nitrogenous waste and urea, which results from protein breakdown
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| What is the normal BUN level? | 10 - 20 mg/dL
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| What do you do if BUN level is elevated? | Institute preventive measures to protect patient from possible disorientation or seizures
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| How is creatinine, nitrogenous wastes-urea, and ammonia produced in blood? | Protein breaks down
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| How is creatinine excreted? | By kidneys; directly proportional to renal excretory function
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| What is creatinine used to diagnose? | Impaired kidney function
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| What is affected little by creatinine level, unlike BUN? | Dehydration, malnutrition, or hepatic function
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| What is the normal serum range of creatinine? | Female: 0.5-1.1 mg/dL
Male: 0.6 - 1.2 mg/dL
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| What does IV urography/IV pyelography evaluate? | Structures of urinary tract, filling of renal pelvis w/urine, and transport of urine vial ureters to bladder
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| What do you assess patient for prior to IV urography/pyelography? | Assess for allergy to iodine or iodine containing foods such as iodized salt, shellfish, seaweed products
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| What is the prep for urography/pyelography? | Light evening meal, non-gas-forming laxative evening before, NPO 8 hrs before the test
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| When are x-rays taken during urography/pyelography? | At various intervals to monitor movement of dye
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| What are the affects of aging on the urinary system? | Loss of 50% of kidney filtering by age 70 due to decrease in blood supply to kidneys and loss of nephrons, bladder loses tone, perineal muscles of relax, and incomplete emptying of the bladder
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| What are the nutritional considerations for a patient with urinary dysfunction? | Acid-ash, alkaline-ash, and fluid intake
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| How are kegel exercises done? | Tighten muscles of perineal floor, used for stress incontinence
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| What is total incontinence? | Complete loss of bladder control
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| What is stress incontinence? | Results from the pressure or stressors on the bladder sphincter by events such as sneezing or heavy lifting
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| What is urge incontinence? | Feelings of urgency to void followed by incontinence (associated with Parkinson's and Alzheimer's)
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| What is overflow incontinence? | Repeated inability to fully empty the bladder results in an overly full bladder, which leaks out unexpectedly
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| What is mixed incontinence? | Mixture of both stress and urge incontinence
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| What is functional incontinence? | Influence of mental and physical impairments resulting in an inability to make it to the toilet in time to void
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| Why is urinary incontinence common in older adults? | Weakened musculature in bladder & urethra, diminished neurologic sensation combined with decreased bladder capacity, effects of medication such as diuretics, and urinary stasis
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| What are the NI for UI? | Frequent toileting, meticulous skin care, avoid alcohol, caffeine, and spicy foods, and bladder training
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| What is the most common causative agent in UTI? | Bacteria - E Coli
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| Why are females more susceptible to UTI? | Shorter urethra that is proximal to the vagina and rectum
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| What are the s/s to UTI? | Urgency, frequency, pain/burning on urination, nocturia, abdominal discomfort, perineal pain, or back pain, and urine may be cloudy or blood tinged
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| What is cystitis caused by? | Urethrovesical reflux, introduction of a catheter or similar instrument, or contamination from feces
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| What is interstitial cystitis (IC)? | Chronic pelvic pain disorder with recurring discomfort or pain in the urinary bladder and surrounding region
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| What foods do you avoid for IC? | Food and beverages that cause bladder irritation such as aged cheese, alcohol, artificial sweeteners, chocolate, citrus juices, onions, soy, caffeine, and tomatoes
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| What are the nursing interventions for prostatitis? | Warm sitz bath and analgesics for pain, stool softeners
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| What is the difference in acute and chronic prostatitis? | Acute - avoid sexual arousal & intercourse to rest prostate
Chronic - intercourse may be beneficial
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| What is urolithiasis? | Formulation of calculi in the urinary tract; develops from minerals that have precipitated out of solution and adhere, forming stones that vary in size & shape
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| What is the result if urolithiasis is left untreated? | Hydronephrosis
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| What is the NI for urolithiasis? | Encourage at least 2 L fluid/day, strain all urine (send found stones to lab)
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| What dietary changes should a patient with urolithiasis have? | Reduced calcium, reduced phosphorus, and reduced purine foods (cheese, greens, whole grains, carbonated beverages, nuts, chocolate, shellfish, and organ meats
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| What are the risk factors with renal tumors? | History of dialysis, family history, hypertension, horseshoe kidney, polycystic kidney disease, and smoking
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| What are the s/s of polycystic kidney disease (PKD)? | Abdominal & flank pain, headache, GI complaints, voiding disturbances, and history of recurrent UTI's
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| What are the s/s of benign prostatic hypertrophy (BPH)? | Decreased force of stream of urine (early symptom), difficulty starting stream of urine, painful urination, frequency of urination, nocturia
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| What are the complication of urinary obstruction? | UTI, hematuria, and oliguria
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| What medications are used to treat BPH? | Alpha blockers, which improve ability to urinate by relaxing both the bladder neck and the fibers of the prostate
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| What are examples of alpha blockers? | terazosin (Hytrin), doxazosin (Cadura), and terazosin (Flomax)
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| What medications do you avoid with alpha blockers? | Anticholinergic's, antihistamines, decongestants, and antidepressants
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| What is the standard of surgical intervention for BPH? | TURP - Transurethral resection of the prostate
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| How do you prevent occlusion with TURP? | Continuous or intermittent bladder irrigation
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| How often do you monitor v/s and urine color with TURP? | Every 2 hours for 24 hours
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| What may a patient experience after removing catheter? | Frequency, voiding small amounts with some dribbling
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| What is nephrotic syndrome? | Disorder characterized by marked proteinuria, hyperlipidemia, hypoalbuminemia, and edema
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| What is anasarca? | Severe generalized edema
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| What are the NI for nephrotic syndrome? | Maintain bed rest, assess for electrolyte imbalances, skin care
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| What is the diet for nephrotic syndrome? | Protein replacement, sodium restriction
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| What commonly precedes acute glomerulonephritis? | Sore throat or skin infection (usually streptococci) or SLE
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| What are the s/s of acute glomerulonephritis? | Anorexia, nocturia, edema, crackles in lung sounds, hematuria
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| What is the diet for acute glomerulonephritis? | Protein restriction (to decrease blood urea levels), high carbs, may need sodium & fluid restriction
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| What is the u/o for the oliguric phase of ARF? | Decreases to less than 400 mL/24 hours
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| What is the u/o for the diuretic phase of ARF? | Increases to 1 to 2 L/24 hours
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| What are the s/s of chronic renal failure? | H/A, asthenia (decreased strength or energy), pruritus, elimination changes, anuria, muscle cramps, anemia, and CNS involvement such as disorientation & mental lapses
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| What do you maintain during dialysis? | Asepsis and universal precautions
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| What do you monitor before and after dialysis? | Weigh before and after treatment to determine fluid loss, obtain v/s every 30-60 minutes
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| Who can help patient and family adapt to living with dialysis and transplantation? | American Association of Kidney Patients
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| Describe the most common urinary diversion | Ileal conduit - Ureters are implanted into a loop of ileum that is isolated and brought to surface of abdominal wall; drainage bag is fitted over stoma to contain constant drainage of urine
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| What should the stoma look like postop? | Moist, pink and may bleed slightly and initially may be edematous; mucus will be present in urine from intestinal secretions
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| What does it indicate if BUN & Creatinine levels are increased and RBC are decreased? | Impaired renal function
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| What are the s/e of Lasix? | Excessive urination/hypokalemia, hypochloremia, hyponatremia, hypocalcemia, and/or hypomagnesemia
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| What are the s/s of fluid overload (hypervolemia)? | Changes in pulse rate, respirations, cardiac sounds, and lung fields
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| What are the s/e of thiazide diuretics? | Hypokalemia, hyponatremia, and/or hypercalcemia
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| What are foods that contain potassium? | Baked potatoes, raw bananas, apricots, or navel oranges
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